Background The COVID‐19 pandemic has significantly impacted on those in Residential Aged Care Facilities (RACFs). This research was undertaken to explore and better understand the effects of the pandemic on the experience of next‐of‐kin and carers who encountered the death of a loved one who resided within a RACF during the pandemic. Methods Prospective single‐centre mixed methods research was undertaken involving telephone interview with next‐of‐kin or carers of residents who died within 30 days of being referred to Austin Health Residential Inreach Service during the ‘second wave’ of COVID‐19 in Melbourne, Australia in 2020. Qualitative and quantitative data was collected. Qualitative description and aspects of grounded theory was used for analysing qualitative data. Thematic analysis of the interview transcripts used open and axial coding to identify initial themes and then to group these under major themes. Results Forty‐one telephone interviews were analysed. Major themes identified included: COVID‐19 pandemic; communication and technology; death and dying experience; bereavement and grief; and social supports and external systems. Conclusion Findings from this study identify the many COVID‐19 pandemic related challenges faced by participants and their dying loved one in RACFs. Access to palliative care and bereavement support is crucial for dying residents and for grieving that has been made more difficult by the pandemic. This article is protected by copyright. All rights reserved.

Background Residential InReach presents an alternative to hospital admission for aged care residents swabbed for coronavirus disease 2019 (COVID‐19), although relative outcomes remain unknown. Aims To compare rates and predictors of 28‐day mortality for aged care residents seen by InReach with COVID‐19, or ‘suspected COVID‐19’ (sCOVID), including hospital versus InReach‐based care. Methods Prospective observational study of consecutive patients referred to a Victorian InReach service meeting COVID‐19 testing criteria between April and October 2020 (prevaccine availability). COVID‐19 was determined by positive polymerase chain reaction testing on nasopharyngeal swab. sCOVID‐19 was defined as meeting symptomatic Victorian Government testing criteria but persistently swab negative. Results There were no significant differences in age, sex, Clinical Frailty Score (CFS) or Charlson Comorbidity Index (CCI) between 152 patients with COVID‐19 and 118 patients with sCOVID. Similar results were found for 28‐day mortality between patients with COVID‐19 (35/152, 23%) and sCOVID (32/118, 27%) ( P = 0.4). For the combined cohort, 28‐day mortality was associated with initial oxygen saturation ( P < 0.001), delirium ( P < 0.001), hospital transfer for acuity ( P = 0.02; but not public health/facility reasons), CFS ( P = 0.04), prior ischaemic heart disease ( P = 0.01) and dementia ( P = 0.02). For patients with COVID‐19, 28‐day mortality was associated with initial oxygen saturation ( P = 0.02), delirium ( P < 0.001) and hospital transfer for acuity ( P = 0.01), but not public health/facility reasons. Conclusion Unvaccinated aged care residents meeting COVID‐19 testing criteria seen by InReach during a pandemic experience high mortality rates, including with negative swab result. Residents remaining within‐facility (with InReach) experienced similar adjusted mortality odds to residents transferred to hospital for public health/facility‐based reasons, and lower than those transferred for clinical acuity.